Medical Review Nurse
Remote$80k - $90kFull-timePosted 1mo ago
About the role
Medical Reviewer responsible for ensuring DME orders are compliant with CMS regulations, LCDs, and LCAs, bridging policy requirements with operational billing quality in a fully remote, full-time role.
Responsibilities
- Medical Necessity & Compliance Review: Review DMEPOS orders, progress notes, and medical records against coverage policies to confirm medical necessity across diverse DME categories (e.g., Surgical Dressings, CGMs, Insulin Pumps, Wound Care, Ostomy, Urology, CPAP/PAP therapy, Ventilators, Wheelchairs, etc.).
- Provider Education: Communicate findings clearly with healthcare providers and internal teams to bridge documentation gaps and educate stakeholders on evolving coverage criteria.
- Data Security: Maintain strict compliance with HIPAA and enforce disciplined handling of Protected Health Information (PHI) across all workflows.
Qualifications
- Prior experience (3 - 5+ years) with DME pre-authorizations, DME utilization management reviews and/or DME claim audit processes.
- Standard computer literacy and proficiency with medical review software/EHR platforms.
- Excellent written and verbal communication skills with the ability to convey complex policy requirements clearly.
- Proven ability to thrive in a fast-paced environment with a flexible, adaptable mindset.
- Strong team player with a highly collaborative work style.
- Strict adherence to PHI guidelines and patient privacy protocols.
Skills
Required:DME pre-authorizationsCMS regulations familiarityMedical record review
Last updated Sep 16, 2026. Interested? Apply on the company site.
About Verse Medical
Software platform for in-home healthcare
As healthcare costs have increased, the patient's home has become incredibly important as a site of care. Yet, patients recovering at home are highly underserved. Patients can only get better at home if they receive the high-quality care that they need reliably. The existing in-home care process involves patchwork of different vendors, all connected through faxes by nurses. We're building modern, robust software that solves this challenge and brings this market online.
consumer-health-servicesmedical-devices
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